Tracheoesophageal Fistula Symptoms and Treatment

Mon, 22 Jan 2024

Having an improper connection between your esophagus and trachea is a condition known as a tracheoesophageal fistula (TEF). Congenital indicates that the condition developed while the fetus was still developing. TEF can also develop as an adult as a result of cancer, an infection, or trauma. Surgery is used as a treatment to seal the fistula. To get your surgery done consult Dr. Arvind Kumar, one of the best chest surgeons in Delhi. Consult us to book your appointment.

The trachea (windpipe) and esophagus (the hollow tube connecting the throat from your stomach) are normally different structures. Tracheoesophageal fistula (TEF) is a condition in which there is an improper connection between the two organs. As a result, you breathe in food and liquids that end up in your lungs. 

Tracheoesophageal fistula is an abnormal communication between wind and food pipe. Tracheoesophageal fistula can occur due to cancer of the food pipe infiltrating into the windpipe (and rarely, vice versa) or due to non-cancer (benign) causes like prolonged ventilation, trauma, and following some operations.

Causes Of Tracheoesophageal Fistula 

Tracheoesophageal fistula is inherited. In other words, it comes with birth. The majority of TEF instances are detected and treated in childhood.

Adults may also develop tracheoesophageal fistulas called Acquired tracheoesophageal fistula, as an outcome of lung or esophageal cancer, infections (including TB), trauma following a surgical operation, or esophageal cancer or lung cancer. 

Types Of Tracheoesophageal Fistula 

There are several TEF kinds:

• Esophageal atresia with distal TEF (kind C): In this kind, the lower esophagus and trachea are abnormally connected, and the upper esophagus is absent from the lower one.

• Isolated TEF (Type E): This uncommon variant lacks esophageal atresia but has an esophageal-tracheal fistula.

• H-form TEF (Type H): This form does not include esophageal atresia but does entail an esophageal-tracheal fistula. It is frequently seen much later in life.

Symptoms Of Tracheoesophageal Fistula 

Patients suffering from Tracheoesophageal fistula develop a cough on trying to eat or drink anything. Sometimes, it can cause life-threatening choking.

Common indications and symptoms are:

• Choking sensation and coughing when swallowing.
• Lung infection (Aspiration pneumonia), is caused by food or liquid entering the airways.
• Eating difficulties and persistent respiratory infections.
• Voice changes, and a cough that wont stop.
• Excessive production of saliva.

Tracheoesophageal Fistula (TEF) Diagnosis

Tracheoesophageal fistula (TEF) diagnosis frequently entails a mix of clinical evaluations and specialized diagnostics. The diagnosis for Tracheoesophageal fistula is confirmed by Bronchoscopy and Esophagoscopy.

Common diagnostic procedures comprise:

• Physical Exam: A complete physical exam is helpful in identifying important symptoms including choking, coughing, or recurring respiratory infections.
• Chest X-ray: An X-ray examination may identify air in the gastrointestinal tract or irregularities in the lungs and esophagus.
• Contrast Studies: Contrast studies, such as an upper gastrointestinal series or contrast esophagram, require the patient to eat a contrast agent while having X-rays taken. This helps view the esophagus and potential irregularities.
• Endoscopy: To check the esophagus and trachea up close, a flexible tube with a camera is inserted through the mouth or nose.
• Bronchoscopy: In this technique, the trachea and esophagus are examined to see whether there are any connections using a small, flexible tube called a bronchoscope.

Surgery Options For Treating Tracheoesophageal Fistula (TEF) 

Tracheoesophageal Fistula (TEF), is largely treated surgically. For the possible life-threatening consequences of this illness to be alleviated, quick medical care is necessary.

Surgical Procedures

• Primary Repair: When TEF is found, the primary repair is frequently carried out. A cut is made, and the abnormal connection is properly closed by the surgeon.
• Delayed Primary Repair: To stabilize the patients general state prior to surgery if their health is in jeopardy, a delayed primary repair can be suggested.
• Esophagostomy: The surgeon may do an esophagostomy if the space between both the lower and upper esophageal sections is too wide for primary repair. In order to create a feeding opening, this includes moving the upper esophagus close to the surface of the skin. Later, the esophagus is reconnected with a secondary surgical surgery.
• Foker Process: This is a cutting-edge procedure for treating long-gap esophageal atresia. To encourage tissue development, the ends of the esophagus are sutured to tiny traction devices and gradually tightened over a few days. The TEF is mended after a long enough length has been reached.

The treatment consists of disconnection of the fistula (abnormal communication) and closure of resultant holes in the food pipe as well as the windpipe. We usually try to put some living tissue in between these repaired holes. In the neck this procedure can be easily performed by the open method. 

However, in the chest, it requires major Thoracotomy, which has been our teams special area of interest for over a decade. After this extensive experience, now we are in a position to do this complex operation of Tracheoesophageal fistula by Key-hole/robotic method also

Post-Operative Care

After TEF repair, people could need specialized care, such as:

• Feeding tube: Until they are able to swallow properly, many patients receive food using a feeding tube.
• Assistance for the respiratory system: Some people might require short-term oxygen treatment or ventilator assistance. Although to monitor any issues and guarantee the best possible health and recuperation, long-term follow-up treatment is necessary.

In conclusion, surgery is a crucial component in treating tracheoesophageal fistula. Patients have the best chance of staying healthy when timely intervention is done by experts who can perform surgical operations and make sure it is followed actively by thorough post-operative care.

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